Women, Medicine and Health Care

I think it has been an interesting time in the news for woman lately. Starting on a positive note, yesterday it was announced that the Nobel Prize in Medicine was awarded to Elizabeth H. Blackburn, Carol W. Greider and Jack W. Szostak. Their research was on telomeres and telomerases , which are sort of like protective caps of "junk DNA" at the end of chromosomes. When the "junk DNA" is gone, most cells cannot make more and will die off. Stem cells and cancer cells are amongst the cells which can make more telomeres--thus they don't die off like other cells. That is a good thing with it comes to our stem cells and obviously a really bad thing when it comes to cancer cells. It has also provided information about aging. This research on telomeres and telomerases has taught the scientific community much more about the cell cycle and death than was probably anticipated when the Nobel Laureates started their research in the 1970. Yes, I said 1970s. This research was completed int he 1970s and 1980s and results of their research are so essential to understanding the cell cycle, that it is taught at the undergraduate level.

Getting back to my point, there have never been two women that have won the Nobel Prize in Medicine in the same year. In fact, between the years of 1901 and 2008, only 36 times have Nobel Prizes been awarded to women (to 35 different women--Marie Curie, has been honoured twice, with the 1903 Nobel Prize in Physics and the 1911 Nobel Prize in Chemistry won Nobel Prizes). There have been two winners in Physics, three winners in Chemistry, eight winners in Physiology or Medicine, eleven winners in Literature, and twelve winners in Peace. Less than half of the Nobel Prizes won by women have been in the sciences. It is so exciting to have two women win the prize for medicine this year! I've been reading some articles about the lack of women winners. Some have noted that the Nobel Prizes, especially in the sciences, are usually granted years after the research occurred and since historically women were not scientific researchers, women are for today's standards underrepresented due to a delay in time of research completion to recognition. Others have suggested that women have been overlooked. I'm not sure of the answer, but I'm extremely excited that two women have won the award in medicine this year and to top it all off, all three of the winners are Americans!

On the other end of the spectrum, I've read a few articles lately regarding health insurance and women. Did you know that in eight states being a victim of domestic abuse can be considered a pre-existing condition and you can legally and the District of Colombia be denied insurance? I guess from an insurer's prospective this makes complete sense. A women who is abused would be more likely to get back into another abusive relationship or even return to her abuser. It makes sense that an insurer wouldn't want to pay for the broken bones, bruises, ruptured organs that could ensue if they insured someone with this history. Insuring this person would probably not be a big money maker so I guess that the insurance companies don't want to pay. I, personally, cannot believe that it is legal in some places in the United States to deny insurance because they have been a victim of abuse. If the woman decides to leave, she won't be able to get insurance. I'm not sure of the laws, but I believe that the insurance companies would have access to any mental health medical records, so they would be able to see if a women went to a therapist for help.

I'm probably not the most objective voice regarding pre-existing condition and health care coverage. I've chosen to go into medicine, not because it is a business and a way to profit, but because it is a way to care for others and study science. I don't have a business mind. I guess I think about the patients as people not profits. I know that it isn't fair to blindly judge everyone working in the insurance industry, because they may also disagree with practices of the industry; however, insurance is a business. Maybe the problem is just that: insurance is a business. Health insurance isn't like car insurance. If someone is denied car insurance because he or she habitually gets into accidents, I can understand. In fact, not insuring the person may protect others on the road (presuming that the non-insured person doesn't continue driving illegally). However, if someone is denied health insurance what does that say? The person is too big of a liability. Does it mean that we as a society believe the person is not worth caring for? Now, I'm not an economist, businesswoman or a politician and I have not researched this enough (I do have a set of boards to pass), but what if we had insurance companies that were not-for-profit. What if the profits that insurance companies make, were put right back into the pot and used to care for those using the insurance that were sick. What if there were no pre-existing conditions that would deny someone coverage. I would feel better paying for insurance knowing that if I did get sick, I wouldn't have claims denied because I've maxed out the policy; since rather than making profits for a company, that income would be used to actually insure people are cared for through the entire duration of their illness.

I, like 63% of physicians, support a public plan in the health care reform. I don't know what would be best and I don't know how the best way to put a policy in place, but I know that we, as Americans, need to offer health insurance to all and make it affordable to everyone. I read an article on Newsweek about Italian health care. It didn't sound perfect, but everyone was covered by the state and then you could buy insurance to have things done faster. I don't know if a plan similar to the Italians' is the answer to health care reform, but we have to be able to care for our people here in American like they do abroad. We have to provide some security--I've never head of people anywhere but the United States going bankrupt because of a health problem. Americans are busy doing outstanding research in Medicine, so outstanding that that win Nobel Prizes, now can't we also take care of our people as well?

"I know the price of success: dedication, hardwork and an unremitting devotion to the things you want to see happen." --Frank Lloyd White

It's only a week into my USMLE Step 1 preparations and I'm already starting to feel tired. I think it is easy for people doubt themselves and question, "can I do this" whenever one starts working to achieve a new difficult and challenging project. Last night, I started feeling overwhelmed with the amount of work to do and started wondering if I can do it. There are times that it is really easy to sit down and study for hours and other times when it is not so easy--last night and this morning, it hasn't been so easy. I took a little study break last night and while looking around online I found a few words of encouragement:

"The greatest danger for most is not that our aim is too high and we miss, but that it is too low and we reach it."--Michelangelo

"Don't bunt. Aim out of the ballpark. Aim for the immortals"--David Ogilvy


When I started doubting myself last night, I thought something on the lines of "don't make your goal so high--then you won't feel overwhelmed." Then I saw the above quotes. It really made me think twice about lowering my goals. I've set my goal so high that realistically, I might not be able to reach it. But, who cares? So what if I don't reach that extremely high goal? Even if I miss my goal, I'll still score higher than what I thought I could initially score when I started making goals last May. I've decided to keep my goal sky high and do everything I can to reach it.


"First say to yourself what you will be and then do what you have to do."--Epictetus.


This really describes my medical school path. I first wanted to be a physician at age six when my maternal grandmother was dying of colon cancer. I didn't get into medical school right after college so I gained priceless experience as a clinical researcher. Then I took a huge risk and moved to a third world Caribbean nation that I'd never heard of before. I didn't just survive the experience, I thrived. I never expected that I would have done so well in Dominica--heck I don't even go camping! I really don't want to move back, but overall, life in Dominica was pretty great--excluding the bugs, brown and cold water and lack of groceries. If you want something enough, you just do what you have to do to reach your goals. Sometimes I think about the future--such as the USMLE, moving to Chicago, Washington D.C. or New York City (most likely New York)--and I get overwhelmed. But, I have to remind myself that I've done it before and saw success in my first two years of medical school. Besides, I decided I'm going to be a physician and now I'll do what it takes to get there--I've already done so much!


"Some give up their designs when they have almost reached a goal, while others, on the contrary, obtain victory by exerting, at the last moment, more vigorous efforts than before"--Herodotus


Strangely enough, just admitting that I feel overwhelmed at times has already made me feel more confidant. I know I can do great on these boards and I know that I have the motivation to work hard to achieve my goals. Speaking of hard work, it is time to exert "more vigorous efforts than before!"

Doctors Orders: Two cups of coffee in the morning

Today we were discussing drugs used to treat respiratory disorders, such as asthma and chronic obstructive pulmonary disease (COPD). One class of older drugs methylxanthines, which includes the Theophylline, Aminoophylline and Caffeine, isn't used frequently and are not drugs of choice--nonetheless, we need to review them. These drugs work by inhibiting phosphodiesterase enzymes and blockade of adenosine receptors. Basically this means that they cause bronchodilation (but not as well as beta-2 agonists, such as abulterol), they increase the ventilatory response, increase mucociliary clearance (which is important in asthmatics because the pathology of asthma results in an increase in mucus), and improved diaphragmatic performance, which is unique to this class of drugs. Bottom line, these drugs makes it easier to breathe. I'm sure your wondering why I'm telling you all of this as you probably don't care about mechanisms of action and classes of drugs--if you did care you would be a pharmacists or a physician--I have a story about coffee.

Our lecturer today started teaching medical students in 1956 and is an MD and a PhD. I think he might be the smartest person I've ever met. He is an excellent professor and I think he could teach just about any topic in medicine school at any moment without much preparation. He is amazing in that he is so intelligent, never embarasses students, is extremely helpful and very modest (but he writes extremely difficult exam questions). After discussing the respiratory effects of Methylxanthines, we discussed effects in other systems such as the gastrointestinal tract, genital urinary tract, cardiac system and central nervous system. Obviously caffeine acts on the CNS, which is the point of this blog post. He made a point that moderate doses of caffeine has the following effects on the central nervous system:

• Cortical arousal with increased alertness and deferral of fatigue


• Decreased reaction time, more rapid and clear flow of though, and increased learning capability for simple tasks

Then he bluntly said in a thick Italian accent, "If you need to stay awake to study for your exams, please just have two cups of coffee. It will work better because you will be more alert and is safer than abusing other drugs." Through out the world, people abuse substances, such as Adderall which is an amphetamine, to keep them awake for school or work. I, personally, don't know of anyone who is abusing drugs to stay awake and study, but I do know that it is habitually done in medical schools and I'm sure some of my peers are doing so. It surprised me that he stopped to talk about drug abuse and reasons it is so horrible. Not only is he an amazing professor, I think he truly cares about his students (and he looks like a cute Italian grandpa). Now back to caffeine, there are obviously side effects if you take too high a dose of caffeine including insomnia, headache tremors, and headache (which he also warned us about). Nonetheless, the moral of the story is if you need help staying alert, Doctor's orders: two cups of coffee.

Rest In Peace, H.M.

H.M. was a young man when he underwent an experimental surgery to try and fix a seizure disorder in 1953. They fixed the seizure disorder, but he had anterograde amnesia; oversimplifying it, he couldn't remember after the surgery. He agreed to participated in neurological research and did so for 55 years. Anyone who has taken a course in neuroscience (and probably neuropsychology) knows who H.M. is. In Neuroscience last semester, we talked about H.M. in several different lectures about differing yet related topics. He was involved in so much research that I'm sure that there are entire books written on H.M. If I didn't have exams coming up, I'd explain more about him and what we have learned. Let's put it this way, H.M. is so significant that his brain is being perserved--like Albert Einstein. There are two interesting articles about H.M: the New York Times talked about his life and Slate talked about amnesia in general.

As a medical student and former clinical researcher, I express how much I appreciate everyone who has so shown such altruism as to allow themselves to participate in research, like H.M. There are not enough words to thank the selflessness of those who donate their bodies so students can learn in the cadaver lab or so someone else life can be saved with a transplant surgery. So with much gratitude, thank you H.M. and may you rest in peace. Your contributions to neuroscience and medicine are so vast, so remarkable and unforgettable.

World AIDS Day: December 1st

Amongst all of the happy celebrations that occur this time of year like Thanksgiving, St. Nicholas Day's, Christmas, Chanukah, and New Years, there is a more somber day: World AIDS Day. It is observed on December 1st each year and is a day to bring attention to the world AIDS epidemic. 2008 is the 20th anniversary of World AIDS day. Today we had a lecture on HIV and I thought it would be appropriate to give you some interesting facts we learned during our lecture. The information I've provided is directly from my lecture notes.

AIDS: Number Comparisons

• 40 million people infected worldwide; Population of Canada: 30 million
• Over 21 million people have died from AIDS so far; Population of New-York city 21 million
• Over 13 million children, mostly in Africa, have been orphaned because of AIDS; 15 million students are in primary and secondary school in the United States
• About 1/160 people is infected with AIDS worldwide; about 1/520 people has cancer worldwide
• 16,000 people are infected with HIV daily; 11,000 children are born each day in the United States.

In the United States, it is easy to forget about how horrific HIV/AIDS is since we have such amazing medications that are extending the lives of HIV patients (and giving horrific side effects). Nonetheless, AIDS is still a huge problem worldwide, check out these numbers from UNAIDS and the World Health Organization:

Citation for the Red AIDS ribbon image on this blog post.

You can't believe everything you see on T.V., but you can believe this!

Yesterday in microbiology we were had lectures on "strategies of laboratory diagnosis" and "antibiotics and resistance." During these lectures, our professor mentioned a procedure known as a fecal transplant. It is used for Clostridium difficile (see picture above), which is a bacteria that causes diarrhea. C. diff can be found in the normal flora (normal bacteria) of the gut, but if you are immunosuppressed (cancer patients for example) it can overgrow and run amuck. I suspect that the fecal transplant is used in other bacteria. I am not 100% sure all of the bacteria that are treated with this procedure because when I searched for academic papers, most of them discussing "fecal transplant" were so recently published that I couldn't see the full article online--just the abstracts. I did find news report published by the Canadian Broadcast Cooperation that discusses this medical procedure.

At any rate, on "Grey's Anatomy" last night, they discussed a patient who needed and received a fecal transplant. I am here to tell you that yes, in fact, this procedure is done. From what I know, this is reserved for patients who have had severe diarrhea for a long period of time (so perhaps the case wasn't severe enough to warrant a transplant). Nonetheless, it works when other things don't. I spoke with my professor (a PhD in microbiology) today about the actual procedure and she thought that it was done as an enema, but the next presenter (an MD) said that it would be administered via an NG tube (a tube in the nose, often used to feed patients who cannot eat). Yup, that is correct. Grey's got it right. Fecal transplants do, in medical practice, actually occur.

Dancin'

Farley has brought me over to the dancing side. He thinks it is imperative to dance before each exam, as he explained last February. Well, I hate to admit it when he is right, but I've had an overwhelming dance crave come over me while studying for the exam tomorrow. I even had to download Thriller because I think, with practice, I might be able to dance as well as the inmates in the Philippines. Farley would also say that tomorrow we gotta, "Showin' (professors) How Funky Strong Is Your Fight" but I wish , "It Doesn't Matter Who's Wrong Or Right." Well on that note, I've got to get back to memorizing drugs and bugs, which is clearly not as much fun as dancing or using Jackson's lyrics to describe my "battle" tomorrw, but much more important!